BSDCC 2021 Puppy Membership Form

This new program allows you, as a breeder, to purchase BSDCC Membership for owners of a litter you bred, at a discounted price of $25.

Puppy memberships are valid only until December 31 of the year they purchased and give the puppy owner access to the newsletter for that same period of time.

Payment for Puppy membership must be done by e-transfer only.
Your (breeder) Name*

First NameLast Name
E-mail*
CKC Member #*
BSDCC Member #
Kennel name*
Variety of Belgian Shepherd owned*

GroenendalLaekenoisMalinoisTervueren
Number of puppies*
Cost CA$
read-only field

Puppy #10
Puppy #10 Name
Puppy #10 CKC Application number
XX123456
Puppy #10 Owner name

First NameLast Name
Puppy #10 Owner email
example@example.com
Puppy #10 Owner phone number

Area CodePhone Number
Puppy #10 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #9
Puppy #9 Name
Puppy #9 CKC Application number
XX123456
Puppy #9 Owner name

First NameLast Name
Puppy #9 Owner email
example@example.com
Puppy #9 Owner phone number

Area CodePhone Number
Puppy #9 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #8
Puppy #8 Name
Puppy #8 CKC Application number
XX123456
Puppy #8 Owner name

First NameLast Name
Puppy #8 Owner email
example@example.com
Puppy #8 Owner phone number

Area CodePhone Number
Puppy #8 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #7
Puppy #7 Name
Puppy #7 CKC Application number
XX123456
Puppy #7 Owner name

First NameLast Name
Puppy #7 Owner email
example@example.com
Puppy #7 Owner phone number

Area CodePhone Number
Puppy #7 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #6
Puppy #6 Name
Puppy #6 CKC Application number
XX123456
Puppy #6 Owner name

First NameLast Name
Puppy #6 Owner email
example@example.com
Puppy #6 Owner phone number

Area CodePhone Number
Puppy #6 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #5
Puppy #5 Name
Puppy #5 CKC Application number
XX123456
Puppy #5 Owner name

First NameLast Name
Puppy #5 Owner email
example@example.com
Puppy #5 Owner phone number

Area CodePhone Number
Puppy #5 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #4
Puppy #4 Name
Puppy #4 CKC Application number
XX123456
Puppy #4 Owner name

First NameLast Name
Puppy #4 Owner email
example@example.com
Puppy #4 Owner phone number

Area CodePhone Number
Puppy #4 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #3
Puppy #3 Name
Puppy #3 CKC Application number
XX123456
Puppy #3 Owner name

First NameLast Name
Puppy #3 Owner email
example@example.com
Puppy #3 Owner phone number

Area CodePhone Number
Puppy #3 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #2
Puppy #2 Name
Puppy #2 CKC Application number
XX123456
Puppy #2 Owner name

First NameLast Name
Puppy #2 Owner email
example@example.com
Puppy #2 Owner phone number

Area CodePhone Number
Puppy #2 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Puppy #1
Puppy #1 Name
Puppy #1 CKC Application number
XX123456
Puppy #1 Owner name

First NameLast Name
Puppy #1 Owner email
example@example.com
Puppy #1 Owner phone number

Area CodePhone Number
Puppy #1 Owner address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

To pay for your puppy owners BSDCC membership, please send the amount below as an e-transfer to Treasurer@bsdcc.org
Cost CA$
read-only field
Should be Empty: